ArticleJAMA network open2026
Primary Care by Telehealth and Care Quality in the Veterans Health Administration.
Article in JAMA network open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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8 authors.
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Abstract
Importance: As telehealth (ie, telephone and video) becomes a larger component of primary care, understanding its impact on care quality is critical. Objective: To evaluate whether the proportion of primary care received via telehealth is associated with differences in quality-of-care outcomes among veterans who frequently use primary care. Design, Setting, and Participants: This is a retrospective cohort study of veterans empaneled to Veterans Health Administration (VHA) primary care in fiscal years 2022 and 2023 (October 1, 2021, to September 30, 2023) with 3 or more primary care visits. Telehealth proportion categories were none (0.0% primary care visits telehealth), low (>0.0% to <28.6%), intermediate (28.6% to <50.0%), or high (≥50.0%). Exposure: Proportion of primary care delivered via telehealth. Main Outcomes and Measures: The primary outcomes were influenza vaccination, hypertension control, statin therapy and adherence, and screenings and/or counseling for depression, tobacco, and alcohol use. Multivariable logistic regression was used to estimate adjusted average marginal effects (AMEs), controlling for sociodemographic, geographic, and clinical characteristics. Results: This study included 744 599 veterans (mean [SD] age, 65 [15] years; 638 289 male [86%]). Compared with veterans receiving in-person care only, those who received a low proportion of care via telehealth had similar quality of outcomes for all cardiovascular and behavioral health measures. Influenza vaccination rates were modestly lower in the low-telehealth group vs the in-person only group (age ≥66 years, AME, -1.93% [95% CI, -2.58% to -1.29%]; age 19-65 years, AME, -1.57% [95% CI, -2.28% to -0.86%]). High telehealth users (≥50% telehealth) had the lowest adjusted likelihoods for most quality outcomes, including influenza vaccination (age ≥66 years, AME, -8.96% [95% CI, -9.84% to -8.07%]; age 19-65 years, AME, -9.72% [95% CI, -10.84% to -8.60%]) statin adherence (AME, -2.03% [95% CI -2.93% to -1.14%]) and depression screening (AME, -2.14% [95% CI, -3.20% to -1.08%]). Conclusions and Relevance: In this cohort study of veterans with 3 or more primary care visits, primary care quality was similar for individuals who received all in-person care and those receiving low or intermediate proportions of telehealth. However, high telehealth use was associated with lower quality for several services, especially those requiring in-person interaction. Findings demonstrate the viability of hybrid telehealth and in-person models. Additional resources might be needed to ensure high-quality primary care for high proportion telehealth users.
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